Tuesday, September 04, 2007

ascaris

i was doing a gastroscopy. the patient had a previous gastroenterostomy (small bowel attached to the stomach) somewhere else for unknown reason. the result was, over and above the pyloris (the normal stomach outlet) which was normal, he had another stoma which had an afferent loop and an efferent loop of small bowel. i took a look at all three pipes leaving the stomach, intubating them one at a time.

in the efferent loop is where i saw them!! ascaris!! (see above picture to fully appreciate this little critter). they seemed pissed off that the patient was npo because they were writhing around and moving like mad. even worms get hungry. obviously every one gathered around to take a look. i think it has to do with the fascination of all that is gross.

i just wanted to run. i think i now understand that some people have a rather robust vaso vagal reaction to blood etc, because the same happens with me when confronted with worms.

one of the sisters suggested i take a biopsy. why i wondered. it's not as if i have any doubt as to what it is i'm looking at. anyway, can you imagine how the thing will go crazy if i start taking bites out of it. biopsy is just out of the question here.

i woke him up, gave him deworming treatment and sent him on his merry way.

I don't thing I've blogged about this: when a resident I was running the bowel of a young male trauma victim, stabwound or something equally indicative of a possibly not-nice person. As I was working my way along his bowel, I felt something round/circular. "Wow," I thought. He's a drug-runner (they often swallowed ballons or condoms filled with heroin. As I was pointing out my discovery, the "condom" slithered and moved, and I yelped like a little girl and dropped the bowel as if it had bit me. It was ascaris.

Totally disgusting creatures! Did you ever see the movie about worms? It may have been titled "Worms!" not really sure but I remember the worms rearing their ugly little heads, (or was it their tails?), and screaming when they were hurt or threatened. The people tried to eliminate them by electrocuting the wet ground. Goofy movie but I'll never forget the screams!

AnonIt wasn't "Tremors" (unless there was one long before the Kevin Bacon, Fred Ward version). It was some goofy little B horror movie with a flood and the rise of the earthworms. Not sure what pissed the worms off bad enought to attack, like I said, I just remember the high pitched screams!

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the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.